You watch a monitor, and from the feedback you get, you learn how to use your thoughts and posture to relax the tension in your head, neck, and shoulders.

This is a biofeedback session and it typically lasts up to an hour.

Biofeedback is often used to treat migraine headaches, but there's still some debate about whether it's any more effective than simple relaxation methods. That’s because studies of biofeedback and headaches have yielded mixed results.

But others aren’t as convinced that biofeedback for migraines is better than other treatments. A 2013 review of scientific literature published in the German journal, Schmerz, concluded that biofeedback is no more effective in treating migraines than other relaxation techniques.

Biofeedback Is Just One Option

Biofeedback for migraines is not a panacea for everyone, says Alvin Lake, PhD, a psychologist at the Michigan Headache & Neurological Institute in Ann Arbor, Michigan. “No one has 100 percent efficacy with any treatment,” he says. But Dr. Lake believes that biofeedback can be helpful, especially when combined with other self-help methods, including relaxation, diet, and exercise.

Andrea Imperato, 52, of Easton, Pennsylvania, believes biofeedback has lessened her pain from the debilitating migraines she's suffered for years. Imperato, who learned biofeedback from Lake, was referred to the Michigan center in 2011 because she has complex migraines and head and neck pain.

“When I first went to Michigan, my pain was a 5 on a scale of 1 to 5,” Imperato says. “When I left, I was a 1 to 2 but managing thanks to all they did and the biofeedback.”

Biofeedback Teaches Relaxation

For biofeedback to be effective long term, people need to practice it. “It’s like piano lessons,” Lake says. “The lessons won’t do you any good if you don’t practice and perfect your technique. And if you stop practicing, it may lose its effectiveness.” People who experience frequent stress or anxiety may do well with biofeedback because they may be more motivated, he adds. “The biofeedback skills may help reduce their sense of stress as well as headache.”

Imperato, who still travels to Ann Arbor four times a year to work with Lake, uses the biofeedback strategies he taught her when she feels a migraine coming. “If I’m getting a headache, I can sit down and do what Dr. Lake taught me,” she says. “I close my eyes, visually see what I need to do, and relax the muscles in my head, neck, and shoulders.”

Biofeedback is most useful for preventing headaches. And it might also be useful for migraine sufferers who can’t tolerate or take medication. Lake says others can benefit from combining biofeedback with medication, particularly those with frequent and severe migraines, like Imperato. As one example, when patients combine biofeedback with the medication Inderal (propranolol), they are likely to experience a 70 percent reduction in migraine pain, according to the American Headache Society.

Same Results With Relaxation?

Not everyone is on board, however. In his practice, William Mullally, MD, an associate chief of clinical neurology at Brigham and Women's Faulkner Hospital in Boston, hasn’t found biofeedback to be any more effective for migraines than other behavior modifications.

Dr. Mullally has found that teaching his patients simple relaxation techniques works just as well, and he doesn’t believe patients need to spend extra time and money to be attached to biofeedback machines. Insurance coverage for biofeedback varies and is inconsistent. Mullally says he investigated biofeedback for migraines, thinking he could convince insurance companies to pay for the sessions, but didn’t find the evidence he had hoped.

Imperato has found that the provider can make a difference, too. She says the first time she tried biofeedback in 2000, the staff wasn’t as thorough. She says she wasn’t watching the monitor during her session and recalls that “it didn’t work — I didn’t get much out of it.” Now, she says, she’s had so much success with the technique that it enables her “to take control of her migraines.”